Epidemiologic Reviews最新文献

Previous research has highlighted the role of social determinants of health on mental health, but their impact on suicide is less understood. The aim of this umbrella review was to systematically examine the association between 10 social determinants of health, as defined by the World Health Organization, and suicide mortality. A key word search of titles and abstracts was conducted in six digital databases for studies published up to August 24, 2023. Inclusion criteria were peer-reviewed systematic reviews and meta-analyses examining the association between these determinants and suicide. Methodological quality was assessed using an adapted AMSTAR-2 tool. A narrative synthesis, structured by social determinant, was conducted. A total of 49 records (n = 25 meta-analyses and 24 systematic reviews) were included in this review. Determinants with the most available evidence were housing, basic amenities and the environment (n = 21); income and social protection (n = 13); unemployment (n = 8); and early childhood development (n = 6). Limited evidence was identified for education (n = 3), social inclusion and nondiscrimination (n = 3), and working-life conditions (n = 3). No reviews examined the relationship between affordable health care services, structural conflict, or food insecurity and suicide. There was evidence of a modest effect of social determinants on suicide mortality. Most evidence related to unemployment, job insecurity, income and social protection, and childhood adversity. The methodological quality of the included reviews varied considerably. High-quality research fully exploring the relationship between social and environmental factors and suicide risk is needed.

Dietary fiber plays a key role in preventing chronic diseases, but sex disparities in its health effects remain unclear. This meta-analysis examined the associations between fiber intake and chronic disease risk in men and women; cohort studies reported on in published articles found in the PubMed, Web of Science, and Embase databases were reviewed up to July 2025. Among 2 408 576 participants (n = 1 035 449 men and 1 392 820 women) from 20 studies, higher fiber intake was linked to reduced chronic disease risk in both sexes, with a pooled hazard ratio (HR) of 0.80 (95% CI, 0.75-0.84) for men and 0.83 (95% CI, 0.76-0.91) for women. Notably, fiber significantly lowered cancer risk only in men (HR = 0.81; 95% CI, 0.75-0.87). Grains and vegetable fiber reduced chronic disease risk in men (HR = 0.90 and 0.86, respectively), whereas no specific fiber source had significant benefits for women. In conclusion, although dietary fiber significantly reduced the risk of chronic diseases for both sexes, the threshold for observing beneficial effects is lower in men compared with women, in whom its impact may be more susceptible to confounding factors. More research is needed to clarify sex-specific dietary recommendations for chronic disease prevention.

Epidemiologic studies have linked several modifiable factors to the risk of sleep apnea (SA). However, which specific factors affect the risk of SA and the strength of these effects are unclear. We conducted meta-analyses based on cross-sectional, cohort, and case-control studies found in the PubMed, Scopus, and Web of Science databases up to August 1, 2023. Studies that reported 1 of the associations of education level, physical activity, sedentary behavior, smoking status, alcohol consumption, or coffee consumption with SA were included. Two independent investigators assessed the risk of bias using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality scale. Two-sample Mendelian randomization (MR) studies then were conducted to clarify the causality further. A total of 49 studies were included in the meta-analysis (N = 429 809 study participants). Compared with the other categorial groups, lower level of education (odds ratio [OR] = 1.58; 95% CI, 1.28-1.96), higher level of sedentary behavior (OR = 1.22; 95% CI, 1.01-1.47), current smoking status (OR = 1.33; 95% CI, 1.17-1.51), and current alcohol consumption (OR = 1.40; 95% CI, 1.33-1.48) were associated with higher risk of SA. Higher level of physical activity (OR = 0.77; 95% CI, 0.70-0.83) was associated with lower risk of SA. In the MR study, years of educational attainment were associated with a lower risk of SA (OR = 0.83; 95% CI, 0.78-0.88), and smoking initiation was associated with a higher risk of SA (OR = 1.10; 95% CI, 1.05-1.15). Prevention strategies for SA should focus on modifying these risk factors, especially reducing education inequalities and smoking initiation. Trial registration: PROSPERO identifier: CRD42022319988.

The Gulf Cooperation Council (GCC) countries face a substantial impact from the increasing prevalence of diabetes mellitus, which experts identify as a major public health challenge in the region. Despite the escalating burden of diabetes mellitus and its related complications, including diabetic foot disease (DFD), there are noteworthy knowledge gaps concerning the prevalence and trends of DFD in the GCC countries. Furthermore, there is insufficient understanding of the management of DFD within health care settings in this region. The objective of this scoping review is to comprehensively assess the extent and nature of DFD management across different health care settings in GCC countries. The study will use the population, concept, and context framework: the population of interest is individuals with DFD, the concept is the management or treatment of DFD or its complications, and the context includes the GCC countries. The review will include published articles and unpublished quantitative and qualitative research papers, from 1981 onward, aligning with the establishment of the first multidisciplinary team diabetic foot clinic at King's College Hospital, London. The scoping review will follow guidelines from Joanna Briggs Institute (JBI) and be reported following the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews Checklist. A comprehensive search will be conducted, across various databases including CINAHL, MEDLINE (Ovid), Embase, Scopus, Cochrane CENTRAL, PsycINFO, Global Health, and the Arabic database Al Manhal, and gray literature sources. Studies in Arabic and English language will be included. A data extraction tool will be used to extract the data and will enable a chronological narrative synthesis of results.

Although COVID-19 vaccines are generally very safe, the risks of myocarditis and pericarditis after receiving an messenger RNA (mRNA) vaccine have been established, with the highest risk in young men. Most systematic reviews and meta-analyses of the risk of myocarditis or pericarditis have included passive surveillance data, which is subject to reporting errors. Accurate measures of age-, sex-, and vaccine dose- and type-specific risks are crucial for assessment of the benefits and risks of the vaccination. A systematic review and meta-analysis of the risks of myocarditis and pericarditis attributable COVID-19 vaccines were conducted, stratified by age groups, sex, vaccine type, and vaccine dose. Five electronic databases and gray literature sources were searched on November 21, 2023. Article about studies that compared a COVID-19-vaccinated group with an unvaccinated group or time period (eg, self-controlled) were included. Passive surveillance data were excluded. Meta-analyses were conducted using random-effects models. A total of 4030 records were identified; ultimately, 17 articles were included in this review. Compared with unvaccinated groups or unvaccinated time periods, the highest attributable risk of myocarditis or pericarditis was observed after the second dose in boys aged 12-17 years (10.18 per 100 000 doses [95% CI, 0.50-19.87]) of the BNT162b2 vaccine and in young men aged 18-24 years (attributable risk, 20.02 per 100 000 doses [95% CI, 10.47-29.57]) for the mRNA-1273 vaccine. The stratified results based on active surveillance data provide the most accurate available estimates of the risks of myocarditis and pericarditis attributable to specific COVID-19 vaccinations for specific populations. Trial registration: International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42023443343.

Food insecurity disproportionately affects women during their reproductive years. Food insecurity is associated with many negative health outcomes in the general population, including hypertension, diabetes, depression, anxiety, and obesity, particularly in women, yet it remains unclear whether it has negative implications for perinatal outcomes. We conducted a systematic scoping review using PubMed, Embase, and Scopus to identify studies of food insecurity and perinatal outcomes, including preterm birth, birth weight, gestational diabetes, hypertensive disorders of pregnancy, gestational weight gain, and mental health outcomes during the perinatal and immediate postpartum periods, and breastfeeding initiation. Twenty-nine studies were included. There is consistent evidence that individuals experiencing food insecurity in the prenatal period are at greater risk for depression and anxiety during pregnancy and postpartum. The findings were inconclusive for preterm delivery, birth weight, and other pregnancy outcomes, including gestational diabetes, hypertensive disorders of pregnancy, and gestational weight gain. This review highlights important data gaps related to the assessment of food insecurity in pregnancy that must be addressed to draw conclusions about potential perinatal outcomes among those experiencing food insecurity. More research is needed to understand the impacts of food insecurity on pregnancy outcomes and assess whether efforts to alleviate food insecurity improve outcomes.

Racial and ethnic minorities have been disproportionally burdened by hospitalization and death due to COVID-19. Participation of individuals of diverse races and ethnicities in clinical trials, according to study-level characteristics of randomized controlled trials (RCTs) that test effectiveness of COVID-19 drugs, could be insightful for future researchers. Our objective for this scoping review was to describe the frequency of race and ethnicity reported as demographic variables and specific reporting of race and ethnicity according to COVID-19 RCT characteristics. We conducted comprehensive searches in PubMed, ProQuest, World Health Organization Database, and Cochrane Central Register of Controlled Trials, and gray literature via preprint servers from January 1, 2020, to May 4, 2022. We included RCTs on emergency- or conditionally approved COVID-19 drug interventions (remdesivir, baricitinib, and molnupiravir) with or without comparators. Self-reported race as American Indian/Pacific Islander, Asian, Black/African American, or White, ethnicity as Hispanic/Latinx, study design characteristics, and participant-relevant data were collected. In total, 17 RCTs with 17 935 participants were included. Most (n = 13; 76%) reported at least 1 race and ethnicity and were US-based, industry-funded RCTs. Asian, Black, Latinx, and White participants were mostly enrolled in RCTs that studied remdesivir. Native American and Hawaiian participants were mostly assessed for progression to high-flow oxygen/noninvasive ventilation. Time to recovery was assessed predominantly in Black and White participants, whereas hospitalization or death was mostly assessed in Asian, Latinx, and multirace participants. Trialists should be aware of RCT-level factors and characteristics that may be associated with low participation of racial and ethnic minorities, which could inform evidence-based interventions to increase minority participation.

Dengue fever, caused by the dengue virus (DENV) and transmitted by Aedes aegypti mosquitos, remains a global health concern with no definitive treatment. Given the challenges in vaccine development and disease management, micronutrients such as vitamin D have emerged as potential adjunctive therapies because of their immunomodulatory properties. The effectiveness of vitamin D in the prevention and control of dengue fever was assessed in this systematic review by evaluating vitamin D's impact on immune responses, viral replication, and clinical outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, relevant studies were retrieved from the PubMed, Web of Science, and Scopus databases. Inclusion criteria encompassed studies examining the association between vitamin D and DENV infection, disease severity, and immune modulation. Six studies met the inclusion criteria. Findings indicated that vitamin D supplementation reduced pro-inflammatory cytokine levels, enhanced macrophage responses, and modulated toll-like receptor activity. Higher vitamin D levels were associated with lower viral replication and milder clinical manifestations of dengue fever. Vitamin D demonstrates potential as an adjunctive therapy for dengue fever by modulating immune responses and reducing disease severity. More clinical trials are required to validate its therapeutic efficacy and determine optimal supplementation strategies. Trial registration: International Prospective Register of Systematic Review identifier: CRD42021231605.

This systematic review was conducted to identify effect modification and interaction factors that moderate the association between socioeconomic status (SES) and smoking behavior among adolescents. We searched the PubMed, Embase, PsycINFO, and Web of Science databases using keywords including "adolescents," "smoking," "inequality," "effect modification," and "interaction." Peer-reviewed articles published in English or French between January 1, 2011, and December 31, 2021, were included, as were relevant studies identified from reference lists. Of 3485 articles, 23 met the eligibility criteria. All reported quantitative observational study designs to identify factors that modify the SES-smoking behavior association. Two independent reviewers extracted data from each article, using a standardized form. Reporting quality was assessed using the Strengthening the Reporting of Observational Articles in Epidemiology guidelines. Of 23 studies, 13 reported statistically significant moderation associations. The most frequently studied moderators were race/ethnicity (n = 5; significant in 4) and sex (n = 5; no significant associations). Contextual factors, including school-level SES (n = 2; significant in 1), neighborhood SES (n = 2; significant in both), and peer influence (n = 2; significant in both), were also examined. Time trends (n = 2), country-level factors (n = 2), and social capital (n = 1) were significant moderators in the few studies that investigated them. Methodologically, adherence to best practices was limited. This review highlights the need for use of a wider range of SES measures, exploration of understudied potential moderators, and consistent adherence to standardized methodologies to better inform public health interventions addressing adolescent smoking inequalities.

Low socioeconomic status (SES) has been associated with an increased risk of depression and psychiatric disorders in general. In this systematic review and meta-analysis, we provide an estimate of the risk of clinical depression associated with low SES across cultures, age groups, and study designs. Finally, we tested whether associations between SES and depression differed by the income of the country in which the study was conducted. A literature search across 5 databases returned 7943 studies. Title, abstract, and full-text screening resulted in 162 included studies of which 122 were meta-analyzed, 22 were included in a cross-sectional narrative review, and 19 studies were included in a longitudinal narrative review. Meta-analyses were divided into risk estimates for composite SES, income, education, and employment. Sensitivity analyses based on differences in economic situation in the country of study origin were performed to investigate a possible source of between-study heterogeneity. Low SES was associated with an increased risk of depression across all measures of SES. Low income was associated with the highest odds ratio for depression (1.96; 95% CI, 1.53-2.52). Sensitivity analyses revealed no significant differences in between-study heterogeneity or risk of depression between high- and low-income economy groups. Comparable risks of depression across economy groups suggest that income relative to your peers, rather than absolute income, is a risk factor for depression. Preventive measures and possible policy interventions are discussed.